Urgencies

Pre-hospital urgency

The origins of pre-hospital transport are not recent. Indeed, with the Life century, the Mauricius emperor was the first to create a body of riders in charge of the collecting of wounded and their transport in the barbers (surgeons of the time). It will have unfortunately to be waited until 1544 before an initiative of this kind is taken again in the person of François 1st who created the large office of the poor charged to go to seek in residence the poor and too weak patients to go to the Hotel God. During the war of Korea and the Second world war, the American department of health will be the first to be obtained emergency material, aiming to the déchoquage on the spot patients in cardiac arrest. While taking as a starting point this experiment, on January 5th, 1949, the French ministry in charge of health published the first circular relating to the organization of the emergency helps. In 1958, professor BOURRET (in Salon of Provence) takes the initiative to send, directly on the spot of the accidents, a doctor in a vehicle equipped to deal with it (them) distress (S) vital (S) in a extra-hospital medium. Allured by these steps, the ministry for health publishes on July 27th, 1960 a circular authorizing the experimental creation of antennas of road reanimation. Thus emergency medicine is capable to leave the walls of the hospital and makes the proof that an assumption of responsibility specialized on the spot is beneficial for the vital prognosis of the patient. This allows in 1965 the promulgation of two decrees leading to the creation of SMUR:

on December 2nd the ministry obliges certain hospitals to obtain average mobiles of help and emergency care;
on December 31st it declares that “the hospital must leave its walls to carry medical help to any person who needs some”. These doctrines are always current and are opposed to the American design pre-hospital urgency which on the spot prescribes not médicaliser the patients, but “to pack them” and to quickly transfer them towards the hospital (it is what one calls the pack-and-run).

Thereafter, the Service of Medical aid urgently (SAMU]) in charge of the coordination of SMUR and “the 15” (free and national phone number for the urgencies medical) are created respectively in 1970 and 1978. It will be necessary, nevertheless, to await the law n° 86-11 of January 6th, 1986 to offer a legal recognition to the two structures (SAMU and SMUR). In order to help us to make the inventory of fixtures of the practice of the pre-hospital urgency we must lean on the three elements who will determine his operation and its evolution: philosophical and scientific designs of the urgency, the socio-economic components (which explain the need for such emergency structures and limit the cost of it) and the organization of these preexistent structures, their resources, human and material, and their operating process.

Urgency a philosophical and scientific problem

In spite of secular reflections (Hippocrates already tried to define the urgency in Ve century before Jesus-Christ), it is interesting to note “the absence of medical or administrative definition of the urgency term”. In the field of medical sciences, this term belongs to the medical paradigm. A paradigm is “the conceptual framework inside whose a science reasons to solve the problems concerned with their discipline”. To some extent, it is to be brought closer to what are the axioms for the geometry. In this context, the direction of the terms like “urgencies”, “health conditions” and “states of disease”, being part of the medical paradigm, “is not regarded as a scientific problem in oneself” but, on the contrary, is held “like bench”. In practice urgencies pre-hospital, the heterogeneity of the emergency concept is explained by its variation according to four principal criteria:

the flow of the situations considered as urgent: the priorities will not be the same one according to whether we are opposite a case isolated or a massive surge from casualties;
the type of encountered problem: medical (“true urgency”, a such polytraumatism, or “felt urgency”, following the example strong cardiac palpitations) and/or medico-social (elderly, little inserted socially, drug addicts or in a psychological state of distress);
need for lavishing technical care of quality with precocity: serious cases of distresses (which “represent only one small percentage”, in spite of the Greek root of the urgency term: urgens, meaning in a hurry);
possession by the mobile service or the proximity of materials or structures adapted to the situation (a such plate médico-technique).

Thus, the urgent situations met are very complex. In comparison with the performance of the new medical methods of care with respect to the vital prognosis, the technical component of the assumption of responsibility of these situations often erases the single character of each one of it.

Socio-economic dimension

They is clean Western companies to give a considerable importance to the urgency and its assumption of responsibility: first of all, it is a problem largely amplified by the media; it is enough to see the role of catalysts which they exploited the rising of conscience with respect to the deaths of elderly during the heat wave of the summer 2003.

In addition, the company tends today to reject on the services of urgencies hospital and pre-hospital “all that encumbers it and disturbs it”. Indeed, it is easy for the family, the neighbors and even for the police force or the health professionals to discharge on the services from urgencies when they are vis-a-vis a person of which they do not manage them-even to solve the medical problems, psychological or social.

Moreover, near a more and more informed public, the hospital SMUR, just like institutions, find themselves vis-a-vis an increased requirement. Moreover, for this reason, they fit in a Démarche quality.

Lastly, in our economic context, our system of cover health is unceasingly discussed again because of its cost, the successive governments did not have of cease to seek to reduce “the cost of health” in France. The recourse more and more running to the services of urgencies weighs, thus, a considerable weight in the economic management of health. Moreover, this assumption of responsibility appears free, because of absence of obligation to advance the expenses of care, and thus does not allow the patient to become aware of the real costs of the services.

The organization of the network of the pre-hospital urgencies in France

In accordance with the law of January 6th, 1986 on the Urgent Medical assistance (AMU) each department is equipped with a center with reception and management with the urgent medical calls (SAMU) and means of intervention to face the request, with the image of SMUR for the serious urgencies. The doctrines of this law are that “the AMU in relation to the communal and departmental devices of organization of the helps, must make ensure the patients, wounded and parturients, in some places which they are, the care of urgencies appropriate to their state”. Our talk being centered on the looking after practice we will not develop the operation of the SAMU. SMUR, as for them, are attached to SAMU department and the urgencies of the principal hospitals of this one which place at their disposal:

of the means of transport, of type Conveys Radio-Médicalisé (light vehicle) or of Hospital Mobile Unité type (UMH) or Ambulances of Reanimation (AR) consistent in the ambulance especially equipped;
the hardware requirement with the assumption of responsibility of a patient presenting a vital distress;
a medicalized team, made up of a hospital driver (titular of the Certificate of Control of Ambulance) and of an assisted doctor, at best, of a Male nurse Graduate Anesthetist of State (IADE) or of a IDE, according to decree 97-620 of May 30th, 1997.

The SMUR are helped in their tasks by: - Associations of liberal urgentists (type S.O.S doctors) - the general doctors who ensure of the “guards” and by - the firemen who can, in first intention, to quickly project on the spot of intervention of the Vehicles of Help and Assistance to Victims (VSAV) armed with three first-aid workers and able to transport a victim. By convention with the hospitals managing SMUR, certain groupings of firemen (as battalion X) are authorized to arm with the named UMH ambulances of réaniamtion and to take part of the kind in the medicalized helps. ---A book out of the commun run, devoted to the actors of the urgency: “in the middle of L `action URGENCIES” with the editions STAY, author: Louis-Frederic Dunal, (June 2007).

S.O.S Médecins is a network of 70 associations of liberal urgentists, divided on the whole of the French territory, and represented by a federal level: S.O.S Doctors France. These associations function 24:00 /24 in close cooperation with Samu of which it are one of principal the effector. They have their own standard accessible by a single national number (0820.33.24.24), and are inter-connected with center 15 by the means of a direct phone line.

Within the framework of the pre-hospital urgency in France, the objective is thus to make come the doctor to the patient, it will also act, as in any other hospital service, to give care to the patients.

External bonds

Waiter of emergency medicine (Online Urgencies - University Paris V)

Simple: Medical emergency

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